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Department of Toxic Substances control <br /> State of California—California Environmental Protection Agency � �,® p E <br /> Orphan Appliance Monthiy Report Form RE ®WI <br /> /p <br /> Please send this document on a monthly basis to DTSC by mailing to: OCT 6 207 <br /> Attn: Consumer Products Section <br /> Department of Toxic Substances Control <br /> Office of Pollution Prevention and Green TechnologyENVIRONMEN I Aa- HEALTI <br /> 1001 "1" Street, 11th Floor DEPARTMENT <br /> P.O. Box 806 <br /> Sacramento, California 95812-0806 <br /> Month: S Year: �LO J <br /> Name of scrap recycling facility. <br /> Facility address: � � ' <br /> Name of CAR: I,LSR S CAR # <br /> Total number of "orphan" appliances received this month (as indicated by use of DTSC <br /> Form 1459) received: <br /> This information is not required, but is appreciated: <br /> Space Heaters: Stove,:: E5 <br /> Refrigerators: Boilers: <br /> Freezers: Furnaces: <br /> Microwaves: � Water Heaters: %0Z. <br /> Washers: Air conditioners: <br /> Dryers: l �b Trash compacters: <br /> Other (please specify): <br /> f <br /> The names and addresses of each person who transported, delivered, or sold "orphan" <br /> appliances to this scrap recycling facility is included on the following additional pages. <br /> This information has also been submitted to my CUPA. <br /> Sincerely, <br /> Universal Service Recycling, Inc. <br /> Paul Bischofberger <br /> ...... ...... ... IIVI. 11 <br /> Environmental Health&Safety <br /> Name <br /> lCl R <br /> ,Y 209•944•955.5 <br /> FAX:209•944-5552 <br /> CELL: 209•855• 1715 ... <br /> Contact Information 3200 South LI Dorado Street,Stockton,CA 95206 <br /> E-mail: Pbischofberger@usrscrap.com <br /> www.usrscrap.com Page 1 of 1 <br /> DTSC Form 1468(1/16/09) <br />